In B3.3 fractures there is a multifragmentary fracture on the lateral side, associated with a fracture of the posterolateral tibia, and a transverse fracture on the medial side.
As the tibial fractures are intra-articular injuries, they should be fixed anatomically.
It is possible to obtain good access to the posterolateral fracture and fibular fracture through a single posterolateral approach. Direct reduction of the Volkmann's fragment is possible, facilitating anatomic reduction and fixation. This requires the patient to be positioned prone.
Alternatively, the fibular fracture can be fixed through a standard lateral approach and the Volkmann's fragment can be indirectly reduced by dorsiflexing the ankle and then secured with screws inserted through anterior stab incisions.